The Flu (Part 2): The Emergency Department

by Leighann on December 23, 2010

After an unexpected vomiting episode, my inability to keep juice in Q and keep her blood sugar up despite suspending her basal insulin, and the development of ketones, I rushed her across town to the emergency department at 1:30 in the morning. (Read The Flu (Part 1): On a Dime.)

The triage nurse asked what her blood sugar was as I checked it yet again. 92. She said, “You consider that low?” Why yes. Yes I do consider that low for my child in the middle of the night. I do consider that low for my child who is vomiting over and over. I do consider that low given that’s the highest I’ve been able to get her even suspending her insulin delivery.

Why are nurses so narrowly educated about diabetes? For the non-diabetic, 92 is a perfectly fine number. But this nurse almost didn’t seem to think that 92 was an “emergency” situation as I did because it seemed perfectly acceptable to her.

Trying to skip a few steps and speed things along, I told her that the doctor needed to call the endocrinologist that I had been consulting with that night. I asked if she could write down the number and name so that the doctor could call right away. “No, the doctors don’t do that.”

But I of course know that they will based on our previous experience. I know that they do this because there is not a doctor that will make decisions about diabetes care for children in our city. I know they will because the endo on call told me to have them do it. I know they will.

I said she needs to get on a glucose drip right away to bring her blood sugar up and she needs anti-nausea medication to stop the vomiting. She tells me the doctors will decide this.

I know this is what she needs. The endo on call told me this. I know this from our previous experience.

I was about to begin protesting but luckily we were moved to a room right away.

More vomiting and the doctor, examining it, said we were way beyond throwing up food, this was bile. That after the first time I shouldn’t have given her juice because she was just going to throw it up again. That I should have given sips of water. But I explained that I was trying to get some carbs in her at the time.

This time the IV went in with relative ease and few screams (but not totally without protest, nervousness, and a few screams). Dextrose drip in. Anti-nausea medicine given.

An aid saw me trying to get comfortable in a chair and found me a recliner.

We tried several times unsuccessfully to get Q to give a urine sample, but she was so dehydrated.

In the wee hours the doctor said that if he couldn’t find a pediatrician who would agree to oversee her that she would need to be transported to St. Louis. I pleaded that I really didn’t want to make that trip and asked him to try.

I felt at this point that it was under control. I just needed help when all I knew how to do was exhausted or not working. We just needed that IV and anti-nausea medication and monitoring. I knew she’d be better and released soon. A trip to St. Louis in the middle of the night would be a logistical nightmare. As it was, my husband was home with our sleeping three-year-old.

At maybe 4:00 am the on call pediatrician came to see us. I have a feeling she had to get out of bed to come in. She talked about her children at home. (Yes, I know that’s her job when on call to come in at all hours as needed.)

She said that she had reviewed the chart and talked with St. Louis and they would admit her here. We’d be moved to the pediatric ward soon and probably released that afternoon. She said I would be in charge of all of Q’s insulin needs. She said after all, I am “the expert.”

Wow, the response from the nurse made me feel mad just reading it. I felt frustrated just hearing her responses, though I know that what she said is probably protocol, and the BS of 92 would seem ok to her. But I think she should have listened a little more to a mom who obviously knows how to deal with diabetes and knows what’s going on. Plus the endos are so good at talking and calling us, that we do know what we need before we get there because they have told us. There needs to be more education done with hospital nurses. Most where I live don’t even know what to do with pumps, and I’m in Memphis, a big city, so I’m sure small ER’s may be worse!

I wonder how many people with diabetes or their loved ones/caretakers end up hearing “you’re the expert” from ER Docs, or even Endos for that matter.

Recently, we discovered blood drops on the kitchen floor. “D”, has diabetic neuropathy and can’t feel his feet – so immediately “J” knew to do a foot check. Sure enough, a small wound had popped up, requiring D to wear a walking boot (again.) Anyway, the doctor told J that “you’re an expert” – and really it is true. It seems PWD or their caretaker end up knowing the intricacies of individual management better than MDs. After all, the Doc sees you 2-3x a year, and you’re with yourself all the time (unless you’ve got multiple personalities 🙂 ) or you’re with the person you care about just about daily.

I don’t mean to scare anybody with the neuropathy/ulcer stuff … With good blood sugar control many of the complications of diabetes can be avoided. Consistently high blood sugar over a long period of time will do the most damage. (That’s why many Doctors argue for aggressive blood sugar control, even though it can increase the risk for hypoglycemia.)

In sum, I think it’s important to “be your own expert” – but also am always disappointed when medical professionals don’t listen to the patients or trust them as the experts they are. (I too can’t believe the “No, doctors don’t do that” experience!!?!)

It is amazing how they just don’t get it!! We live an hour from Nashville and had to make a dash there at Thankgiving due to the nasty stomach virus. My 8yr old went from fine to dehydrated in about 3 hours. Luckily, the children’s ER at Vandy knows how to handle Endo patients and took care of everything ASAP, didn’t even have to wait. They took his name and his bp, then we were on a bed in no time. He was diagnosed when he was 4 and this was our very first experience with being “sick” and I’m grateful we were close enough to a great facility. I am so sorry your experience was so bad!! Blessings to you and Q

I truly wish that local area hospitals that normally do not provide special services such as Pediatric Endocrinology listen & rely on parents more instead of blowing us off. I’m not surprised with the nurses comments especially since as you stated “narrowly educated.” I asked a friend who is a registered nurse and she simply told me that it’s only touched upon in nursing school; diabetes is covered in the adult section of nursing; not pediatrics. The normal range that they are taught is 80-120. With that mindset; it bothers me that some of these nurses truly aren’t qualified to take care of our loved ones due to their lack of education; yet, we must rely on them regardless. I wish as parents we could help educate the local area ER’s that do not normally have type 1 kids on a regular basis but perhaps we should start with program directors of nursing education programs that type 1 diabetes should be covered in more detail in their courses. Nurses are the frontline before the doctors even come to the bedside and nurses are suppose to be patient advocates; so I expect nurses to listen. It angers me that this nurse blew you off especially since you were the only “expert” in the room.

We recently had a two day stay for my son because of the stomach flu. It is always something I fear because everything is so out of control. But we were fortunate to receive excellent care and the experience will help him to handle this when he goes out on his own in a few years.